Form VS 10-13 VS 10-13 Owner/Shipper Certificate Fitness to Travel to a Slaught

According to the Paperwork Reduction Act of 1995, an agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it
displays a valid OMB control number. The valid OMB control number for this information collection is 0579-0332. The time required to complete this information collection is
estimated to average .5 hours per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and
completing and reviewing the collection of information.

OWNER/SHIPPER CERTIFICATE
FITNESS TO TRAVEL TO A SLAUGHTER FACILITY
(Please type or print in ink)

UNITED STATES DEPARTMENT OF AGRICULTURE
ANIMAL AND PLANT HEALTH INSPECTION SERVICE
VETERINARY SERVICES
TIME HORSES LOADED ON CONVEYANCE

OMB APPROVED
0579-0332
Exp. Date XX/XXXX

DATE

CITY AND STATE WHERE HORSES WERE LOADED ON CONVEYANCE

VEHICLE LICENSE NUMBER AND DRIVER NAME

NAME OF AUCTION/MARKET

CONSIGNOR (OWNER/SHIPPER) NAME

CONSIGNEE (RECEIVER/DESTINATION) NAME

STREET ADDRESS

STREET ADDRESS

CITY, STATE, AND ZIP CODE

CITY, STATE, AND ZIP CODE

AREA CODE AND TELEPHONE NUMBER

AREA CODE AND TELEPHONE NUMBER

CHECK THE BOX THAT INDICATES THE FOLLOWING IS TRUE FOR ALL THE HORSES ON THIS CERTIFICATE
Pregnant mares are not likely to foal (give birth) during the trip.
Horses are able to bear weight on all 4 limbs.
Foals are older than 6 months of age.

Horses are not blind in both eyes.

COLOR DESCRIPTION
TAG
PREFIX

TAG
NO.

Bay

Grey

Blk.

Pinto

Chest
-nut

Other

TB

Horses are able to walk unassisted.

BREED/TYPE

SEX

Draft

Stall
ion

QT

Pony

Other

Mare

Gelding

BRANDS
Tattoos,
etc

REMARKS
include
existing
conditions

1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
HORSES HAVE HAD ACCESS TO FOOD, WATER, AND REST FOR A MINIMUM OF 6 CONSECUTIVE HOURS
IMMEDIATELY BEFORE LOADING INTO CONVEYANCE.

CANADIAN FOOD INSPECTION AGENCY (CFIA)
EST.

SIGNATURE

DATE
TIME

I HEREBY AUTHORIZE THE CFIA TO DISCLOSE THIS DOCUMENT AND THE INFORMATION IN IT AS COMPLETED BY
THE CFIA OR DGIF TO THE USDA. FALSIFICATION OF THIS FORM OR KNOWINGLY USING A FALSIFIED FORM IS A
CRIMINAL OFFENSE AND MAY RESULT IN A FINE OF NOT MORE THAN $10,000 OR IMPRISONMENT FOR NOT
MORE THAN 5 YEARS OR BOTH (16 U.S.C. SECTION 1001).

DIRECCION GENERAL DE INSPECCION EN

SIGNATURE OF OWNER/SHIPPER (I certify that the information contained in this form is true and correct
to the best of my knowledge.)

EST.

FRONTERAS (DGIF)

DATE
TIME
VS FORM 10-13
FEB 2018

Previous editions are obsolete
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